臨終處境的陪伴轉化：癌末病患及其照顧者心理經驗與存在現象探究

Transformation in Company: Exploring the Psychological Experiences and Existential Phenomena of End-of-Life Cancer Patients and Their Caregivers

研究目的：本研究主要透過深入訪談，探討末期癌症患者及其主要照顧者對生病事件的感知體驗與存在現象，並瞭解兩者間陪伴轉化。研究方法：本研究以東部某末期病房末期癌症患者及其照顧者為研究對象，研究時程為2012年12月至2013年1月，訪談四對患者和照顧者。三對參與者接受1次訪談；另一對患者接受五次訪談，照顧者接受三次訪談。每次訪談約20~50分鐘。訪談資料轉錄為逐字稿後，以現象學心理學分析方法，分成資料蒐集、沈浸閱讀、意義單元之拆解與改寫、構成主題、置身結構和普遍結構六步驟，進行資料分析與再書寫。研究結果：研究資料分析顯示，一、末期患者呈現模糊存在處境。二、照顧者在靈性信仰的因應與寄遺藏密開封的接應間徘徊。三、患者與照顧者於生死冥界之間遭逢。從末期患者和照顧者間，彼此對生命和死亡的遮掩，到彼此不受俗智與人世間情懷羈絆。最後，臨終啟悟時刻喚起照顧倫理。研究結論：本研究呈現末期世界反而更貼近完整的「此在」而活著，即使患者是以「沉默皺摺」受苦突現「此在」。本研究結果可促使互為主體瞭解生命的陪伴共行，朝向臨終處境的「善終」、「慎終」和「啟悟」。

Purpose: This study used in-depth interviews to explore the sense and impact of cancer illness events on terminal patients and their primary caregivers. Methods: Four patientcaregiver dyads (two male and two female patients with mean age 52.75; 4 female caregivers) were interviewed between one and five times in a hospital in eastern Taiwan. The interviews lasted for 20 to 50 minutes per time depending on the participants' state of mind. The data analysis procedures of carrying out phenomenological psychology were based on six steps: data collection, empathic immersion, meaning units, constituent themes, situated structure, and general structure. Results: First, the terminal patients lived under ambiguous conditions. Second, caregivers’ life trajectories oscillated between the religious coping and forgotten memory recollection. Third, healing encounters occurred between patients and caregivers in the boundary of near death situation. They avoided talking about death with one another initially. Patients and caregivers faced ambiguous loss; they cannot comprehend what happened in that moment at first. Eventually, they understood the transformation in company meant the caring praxis as the re-building the ethical relationships. Conclusions: As experience of death, Being-towards-death can turn over the factical, thrown and limited whole of Being-There (Dasein) into the existential, projected and unlimited whole of Being- There. The end of life is meant to live completely to disclose the ‘Dasein’, what Beingtowards-death meaning is understood at this moment. Silent suffering is existential. The implications from this study and how to enact hospice care are discussed.